Enablers of, and barriers to, optimal glove and mask use for routine care in the emergency department: an ethnographic study of Australian clinicians

Abstract

a b s t r a c tBackground: The risk of healthcare-acquired infection increases during outbreaks of novel infectious diseases. Emergency department (ED) clinicians are at high risk of exposure to both these and common communicable diseases. Personal protective equipment (PPE) is recommended to protect clinicians from acquiring, or becoming vectors of, infection, yet compliance is typically sub-optimal. Little is known about factors that influence use of PPE-specifically gloves and masks-during routine care in the ED. Methods: This was an ethnographic study, incorporating documentation review, field observations and interviews. The theoretical domains framework (TDF) was used to aid thematic analysis and identify relevant enablers of and barriers to optimal PPE use. Results: Thirty-one behavioural themes were identified that influenced participants' use of masks and gloves. There were significant differences, namely: more reported enablers of glove use vs more barriers to mask use. Reasons included more positive unit culture towards glove use, and lower perception of risk via facial contamination. Conclusion: Emerging infectious diseases, spread (among other routes) by respiratory droplets, have caused global outbreaks. Emergency clinicians should ensure that, as with gloves, the use of masks is incorporated into routine cares where appropriate. Further research which examines items of PPE independently is warranted. (R. Barratt).severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS) and pandemic influenza A [2]. Healthcareassociated transmission of these viral infections, into previously unaffected communities, was a key feature of the early stages of, for example, SARS in Toronto and MERS in Seoul [3,4]. A notable feature of both outbreaks was the high proportion of those affected who were healthcare workers, with reports of up to 27% and 57% for MERS and SARS, respectively [5]. First responders and emergency department (ED) clinicians are at high risk of exposure to both common and emerging communicable diseases of high consequence, as they are in close contact with symptomatic patients before a diagnosis is made [5][6][7]. For example, ED staff are among

Determinants of nurse's and personal support worker's adherence to facial protective equipment in a community setting during the COVID-19 pandemic in Ontario, Canada: A pilot study

“…The most commonly-reported barriers to wearing masks, eye protection and face shields were visual (87% of respondents), difficulty communicating (65%), and physical discomfort (57%). These findings are consistent with previous literature which has reported personal barriers including visual clarity, interference with care, and comfort (e.g., fit, heat) as factors influencing non-adherence to FPE 5 ; 9 ; 20 . These findings clearly indicate a need for improvements in fit and comfort to promote increased usage of FPE.…”

Characteristics of personal protective equipment training programs in Australia and New Zealand hospitals: A survey

“…PPE in the recommended manner and few followed the correct order [19]. Poor PPE donning and doffing techniques are unsafe for healthcare workers and patients, contribute to transmission of infection, and are symptomatic of the lack of experience and expertise in PPE use that is due to a just-in-time approach to PPE training during infectious disease emergency responses [20].…”

COVID-19 infection prevention and control procedures and institutional trust: Perceptions of Canadian intensive care and emergency department nurses

“…7 Further, workplace culture, as well as an increased support by local institutions and management, are key factors in adherence to IPC guidelines. [8][9][10] During the COVID-19 pandemic, use of personal protective equipment (PPE) and trust in institutions' differing PPE recommendations and requirements has become a significant issue. While PPE recommendations in hospital settings have been largely consistent, use and availability of equipment has been variable.…”